Assessment of Local Anesthesia Failure During Inferior Alveolar Nerve Block at Dental Clinics in Anambra State

Inferior alveolar nerve block (IANB) is the most widely used regional anesthesia technique for mandibular dental procedures, yet its failure rate remains a persistent clinical challenge, contributing to patient pain and anxiety during oral surgical interventions. This prospective observational study quantifies the incidence, associated factors, and management strategies for IANB failure among patients undergoing mandibular tooth extractions at two government dental clinics in Anambra State, South East Nigeria. Over eight months, 310 consecutive IANB administrations were documented. Success was defined as the absence of pain requiring supplemental analgesia during the procedure. Patient-reported pain scores, anatomical variations, operator experience level, volume of anesthetic used, and injection technique were recorded. Results indicate an overall IANB failure rate of 19.7%, which is consistent with the lower range of published global figures. Patients with acute periapical infections demonstrated significantly higher failure rates, likely due to local tissue acidosis altering anesthetic diffusion. Less experienced operators were associated with higher failure rates independent of other variables. Supplemental infiltration anesthesia was the most common rescue strategy employed. The study recommends structured IANB technique training workshops for dental students and resident doctors in Anambra State institutions, with particular emphasis on anatomical landmarks and infection-modified technique adjustments. Keywords: inferior alveolar nerve block, local anesthesia failure, mandibular extraction, Anambra, South East Nigeria.